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Utilization Review Jobs in Pinckney, MI (NOW HIRING)

Corewell Health

RN Care Coordinator

Northville, MI · On-site

Part Time- 20 Hours A Week Under general direction, integrates cost, quality and utilization to facilitate the admission, continued stay and discharge of the patient. Reviews and evaluates ...

New

Rushton Recovery

Licensed Social Worker

South Lyon, MI · On-site

Proficiency in intake assessments, treatment planning, discharge planning, utilization review, and case management. Join our team and make a meaningful impact on the lives of those we serve through ...

New Oakland Family Centers

Clinical Therapist

Ann Arbor, MI · On-site

$58K - $78K/yr

Complete Utilization Review assignments including but not limited to obtaining authorizations for services provided. * Maintain case files within electronic medical record (EMR) that are up to date ...

Trinity Health

NP/PA Surgery - Urology

Ann Arbor, MI · On-site

$106K - $137K/yr

... utilization review processes. In partnership with the supervising physician, the NP/PA evaluates care based on quality and core measures, access, and cost effectiveness. The NP/PA contributes to ...

Trinity Health

NP/PA Surgery - Urology

Ann Arbor, MI · On-site

$106K - $137K/yr

... utilization review processes. In partnership with the supervising physician the NP/PA evaluates care based on quality and core measures, access and cost effectiveness. The NP/PA contributes to ...

Hope At Home Health Care

RN Field Case Manager

Howell, MI · On-site

$73K - $92K/yr

Participates in utilization review of medical records as assigned. * Gives total patient care as needed. * Takes on-call duty nights, weekends and holidays, as assigned. * Completes and submits OASIS ...

Hope At Home Health Care

RN Field Case Manager

Novi, MI · On-site

$73K - $92K/yr

Participates in utilization review of medical records as assigned. * Gives total patient care as needed. * Takes on-call duty nights, weekends and holidays, as assigned. * Completes and submits OASIS ...

Hope At Home Health Care

RN Field Case Manager

Novi, MI · On-site

$73K - $93K/yr

Participates in utilization review of medical records as assigned. * Gives total patient care as needed. * Takes on-call duty nights, weekends and holidays, as assigned. * Completes and submits OASIS ...

Hope At Home Health Care

RN Field Case Manager

Wixom, MI · On-site

$100K/yr

Participates in utilization review of medical records as assigned. * Gives total patient care as needed. * Takes on-call duty nights, weekends and holidays, as assigned. * Completes and submits OASIS ...

Hope At Home Health Care

RN Field Case Manager

Wixom, MI · On-site

$100K/yr

Participates in utilization review of medical records as assigned. * Gives total patient care as needed. * Takes on-call duty nights, weekends and holidays, as assigned. * Completes and submits OASIS ...

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All JobsUtilization Review JobsUtilization Review Jobs in Pinckney, MI

Utilization Review information

See Pinckney, MI salary details

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$39

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How much do utilization review jobs pay per hour?

As of Aug 9, 2026, the average hourly pay for utilization review in Pinckney, MI is $39.86, according to ZipRecruiter salary data. Most workers in this role earn between $31.49 and $45.77 per hour, depending on experience, location, and employer.

Is utilization review work from home?

Utilization review jobs can often be performed remotely, especially with the increased adoption of telecommuting in healthcare and insurance industries. Many employers offer work-from-home options, provided the reviewer has the necessary certifications and access to electronic health records or claims systems. However, some positions may require on-site presence for meetings or audits.

What does a utilization review do?

A typical day in Utilization Review involves reviewing patient medical records, evaluating the necessity and appropriateness of proposed treatments or services, and documenting recommendations based on clinical criteria and insurance policies. Utilization Review specialists often collaborate closely with physicians, nurses, and insurance representatives to gather additional information and clarify cases. While much of the role is desk-based and may include remote work options, it requires regular communication with both clinical and administrative teams. This position offers variety and challenge, as no two cases are exactly alike, and there are often opportunities to advance into supervisory or quality improvement roles within the department.

Is utilization review a stressful job?

Utilization review is a healthcare role that involves evaluating medical necessity and appropriateness of services, which can be stressful due to strict deadlines, high accuracy requirements, and the need to balance patient care with insurance policies. The job often requires strong attention to detail, communication skills, and the ability to handle complex cases under time pressure.

What is a utilization review?

A Utilization Review (UR) job involves assessing the medical necessity, efficiency, and appropriateness of healthcare services. UR professionals, often nurses or healthcare specialists, review patient records, insurance claims, and treatment plans to ensure they meet industry standards and payer requirements. They work with healthcare providers, insurance companies, and regulatory agencies to optimize care while controlling costs. Their goal is to balance quality patient care with cost-effective resource utilization.

What are the key skills and qualifications needed to thrive in utilization review?

To thrive in Utilization Review, professionals typically need a background in nursing or healthcare, strong clinical assessment capabilities, and a thorough understanding of medical guidelines and insurance regulations. Familiarity with electronic medical records (EMR) systems and utilization management software, and often certification such as Certified Utilization Review Specialist (CURN), are important. Excellent critical thinking, attention to detail, and strong communication skills enable effective case evaluation and collaboration with healthcare teams. These skills and qualifications ensure objective, accurate decisions that support cost-effective, quality patient care within compliance standards.

How do I get into a utilization review?

To become a utilization review specialist, typically a healthcare or related degree such as nursing, health administration, or social work is required. Certification in case management or utilization review, such as the Certified Professional in Healthcare Quality (CPHQ), can enhance job prospects. Relevant skills include knowledge of medical coding, insurance policies, and strong analytical abilities.
What are the most commonly searched types of Utilization Review jobs in Pinckney, MI? The most popular types of Utilization Review jobs in Pinckney, MI are:
What are popular job titles related to Utilization Review jobs in Pinckney, MI? For Utilization Review jobs in Pinckney, MI, the most frequently searched job titles are:
What cities near Pinckney, MI are hiring for Utilization Review jobs? Cities near Pinckney, MI with the most Utilization Review job openings:
Utilization Review jobs near you
Infographic showing various Utilization Review job openings in Pinckney, MI as of August 2026, with employment types broken down into 1% As Needed, 87% Full Time, 10% Part Time, and 2% Contract. Highlights an 89% Physical, 3% Hybrid, and 8% Remote job distribution, with an average salary of $82,906 per year, or $39.9 per hour.

RN Care Coordinator

Corewell Health

Northville, MI • On-site

Other

Posted yesterday

New

Corewell Health rating

7.0

Company rating: 7.0 out of 10

Based on 775 frontline employees who took The Breakroom Quiz

417th of 887 rated healthcare providers

Job description

Part Time- 20 Hours A Week

Under general direction, integrates cost, quality and utilization to facilitate the admission, continued stay and discharge of the patient. Reviews and evaluates appropriateness of admission or continued stay based on medical necessity. The overall goal of the position is to enhance the quality of patient care and engagement, to promote continuity of care and cost effectiveness through the integration and functions of utilization management, and/or care coordination, discharge planning, and appropriate care transitions. Has accountability for the care coordination and discharge planning of all hospitalized patients.

Identifies patients that need care management services (i.e. utilization review; care coordination; and/or discharge/transition planning). Responsible for managing a case load of patients that includes facilitating utilization management, and/or care coordination during the patient's stay, planning and expediting plans for safe and effective discharge and transition to the appropriate level of care and setting needed after hospitalization. Coordinating care by considering all patient's needs. Uses critical thinking and effective judgment to determine alternative courses of care. Judiciously uses tools designed to expedite care while being cost effective. Actively participates in readmission initiatives and strategies to maximize patient flow and appropriate resource utilization. Works collaboratively on processes to provide effective transition for patients utilizing hospital outpatient, observation or inpatient services.

May review cases for medical necessity, uses InterQual and/or other UR/UM Committee-approved medical necessity screening criteria, when appropriate. Works collaboratively with departmental, revenue cycle, and clinical appeals staff, physicians, and payers to obtain authorization for care and appropriate reimbursement. Determines and assures appropriate status and level of care. Uses defined resources to guide decisions, including Medical Director Care Management, Physician Advisors, and management staff. Routinely communicates with payers, patients/family caregivers, physicians, the interdisciplinary team, post-acute and community-based care providers to facilitate coordination of care and to enhance a seamless transition from hospital setting to the appropriate alternative level of care.

Seeks out information and resources to apply creative problem solving for complex discharge/transition planning, quality of care, and utilization management issues. Provides notification and communication to patients/families regarding coverage for hospital and post-acute services, in accordance with CMS regulations. Documents utilization reviews, utilization management actions, care management assessment(s), care plan, discharge plan, and interventions, according to policies, procedures, and regulatory, contractual, and legal requirements. Acts proactively to see that hospital resources are utilized appropriately. Works collaboratively with other departments to define areas of hospital inefficiency and participates in improvement projects.

Qualifications

Required Bachelor's Degree Graduate of an accredited school of nursing. Required Will consider non-BSN RN if actively pursuing a Bachelors degree in nursing with completion within 2 years of hire. 2 years of relevant experience Minimum two years' experience in the acute care setting. Required 3 years of relevant experience Three to five years' experience in care management, utilization review, home care and/or discharge planning. Preferred Registered Nurse (RN) - State of Michigan Upon Hire required CRT-at least one Certification from preferred list - Unknown Unknown Upon Hire required Or Basic Life Support (BLS) - AHA American Heart Association preferred Or Basic Life Support (BLS) - ARC American Red Cross preferred Case Manager, Certified (CCM) - CCMC Commission for Case Manager Certification Upon Hire preferred

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